Eat to Beat Seizures: The high-fat ketogenic diet can help stop seizures in hard-to-treat epilepsy.
Doctors and dietitians explain how it works and how it is implemented.
by Carr, Coeli
Luella Klein had her first seizure at 13 months and was prescribed antiseizure medication. But by the time she was two and a half, the drugs had stopped working and she had developed new symptoms, including a severely imbalanced gait.
During a visit to the Columbia University Medical Center in New York City, Luella underwent a spinal tap to measure glucose levels in her cerebral spinal fluid. Based on the results, she was diagnosed with glucose transporter type 1 deficiency syndrome (Glut1 DS), a genetic metabolic disorder that occurs when glucose, a sugar in the blood, doesn’t reach the brain in levels high enough to be used for fuel. That lack of fuel disrupts brain growth and function and can cause a variety of symptoms, including seizures, movement disorders, speech problems, and developmental delays.
Luella’s doctors recommended that she be put on the ketogenic diet, a high-fat, low-carbohydrate regimen that is standard care for Glut1 DS because it provides an alternate source of fuel—fat—for the glucose-starved brain
Normally, the body converts the carbohydrates in food into glucose, which then becomes fuel for all parts of the body, including the brain. On the ketogenic diet, which restricts carbs and loads up the fat, a different mechanism kicks in: The liver converts fat into fatty acids and ketone bodies, chemicals that “can cross the blood-brain barrier and be used as fuel and may even be anticonvulsant,” explains Eric H. Kossoff, MD, a professor of neurology and pediatrics and medical director of the Ketogenic Diet Center at Johns Hopkins Hospital in Baltimore, MD, and a member of the American Academy of Neurology (AAN). When the body is actively breaking down fat into ketone bodies, which is measured by a simple urine test, a person is said to be “in ketosis.”
To initiate the diet, Luella was hospitalized for five days. Hospitalization makes it easier to determine when a patient is in ketosis and gives doctors an opportunity to educate parents and patients about the diet, says Dr. Kossoff. While there, Luella was fed meals that adhered to a strict three-to-one ratio of fat versus protein and carbohydrates. For example, a meal that contained 1 gram of carbohydrates and 2 grams of protein required 9 grams of fat.
“Within two days of being in ketosis, Luella’s balance, coordination, and walking had noticeably improved, and within a month of being on the diet, her seizures had ceased,” recalls Renee Klein, Luella’s mother.
Now five years old, Luella remains free of seizures thanks to her daily adherence to a high-fat diet that includes plenty of cream and butter.